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Research ArticleOriginal Research

Practice-Based Referrals to a Tobacco Cessation Quit Line: Assessing the Impact of Comparative Feedback vs General Reminders

William C. Wadland, Jodi Summers Holtrop, David Weismantel, Pramod K. Pathak, Huda Fadel and Jeff Powell
The Annals of Family Medicine March 2007, 5 (2) 135-142; DOI: https://doi.org/10.1370/afm.650
William C. Wadland
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Jodi Summers Holtrop
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David Weismantel
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Pramod K. Pathak
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Huda Fadel
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Jeff Powell
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Article Figures & Data

Figures

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  • Figure 1.
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    Figure 1.

    Example of a Quit Line referral report.

  • Figure 2.
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    Figure 2.

    Clinician referrals to Quit Line by quarter.

    Mantel-Haenszel χ2: P <.001.

  • Figure 3.
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    Figure 3.

    Participant disposition and summary outcomes.

Tables

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    Table 1.

    Characteristics of Participating Practices

    CharacteristicTotal No.Interventin No.Control No.PValue
    * χ2 test.
    † t test.
    Recruited, No.874344
    Location, No..69*
        Southeast Michigan1697
        Mid-Michigan231013
        Southwest Michigan17107
        Northern Michigan311417
    Size of community, No..83*
        <5,0001064
        5,000–10,000734
        10,000–25,000261214
        25,000–100,000231013
        >100,00021129
    Proximity to major city, No..76*
        Not within 25 miles291514
        Within 25 miles582830
    Practice type, No..72*
        Solo1367
        2-person16610
        Group practice372017
        Multispecialty group practice211110
    Patients aged >65 years, mean % (SD)24.7 (17.8)21.0 (15.4).34†
    Patients white, non-Hispanic, mean % (SD)78.0 (23.6)82.2 (19.0).38†
    Patients uninsured / Medicaid, mean % (SD)19.5 (18.4)23.3 (20.2).40†
    Estimated smoker visits per quarter, total No.22,16323,537
    • View popup
    Table 2.

    Characteristics of Participating Clinicians

    CharacteristicTotal No.Intervention No.Control No.PValue
    * χ2 test.
    † Fisher’s exact test.
    Recruited308163145
    Sex.69*
        Male1638875
        Female1457570
    Clinician type.95*
        Physician234124110
        Nurse-practitioner311714
        Physician’s assistant432221
    Specialty.45*
        Family medicine1718586
        Internal medicine885038
        Obstetrics-gynecology492821
    Smoking status.45†
        Current321
        Past482919
        Never254129125
    • View popup
    Table 3.

    Estimated Quits by Level of Enrollment in Quit Line

    Enrollment StatusUsual Quit Rate (%)Intervention (n = 484)Control (n = 220)
    * Actual referrals x estimated quit rate = number of quits.
    Level 1, enrolled in Quit Line2573 × 0.25 = 18.2572 × 0.25 = 18.00
    Level 2, brochure and callbacks15126 × 0.15 = 18.9062 × 0.15 = 9.30
    No enrollment, clinician advice only10285 × 0.10 = 28.5086 × 0.10 = 8.60
    Total estimated quits65.6535.90
    • View popup
    Table 4.

    Program Cost per Referral, Enrollee, and Quit

    OutcomeTotal $Intervention $Control $
    QTN = telephone Quit Line service.
    Total cost per outcome
        Cost per referral33.8938.6023.60
        Cost per QTN enrollee71.6593.6838.92
        Cost per quit235.88285.72145.28
    Incremental cost per outcome
        Cost per referral21.6923.5117.70
        Cost per QTN enrollee45.8557.0729.18
        Cost per quit150.93174.04108.93

Additional Files

  • Figures
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  • Supplemental Appendix

    Supplemental Appendix. An Intraclass Correlation Model for a Physician-Based Sampling Scheme.

    Files in this Data Supplement:

    • Supplemental data: Appendix - PDF file, 2 pages, 94KB
  • The Article in Brief

    Practice-Based Referral Rates to a Tobacco Cessation Quit Line: Assessing the Impact of Comparative Feedback vs General Reminders

    William C. Wadland, MD, MS, and colleagues

    Background This study compares two methods of encouraging doctors to refer patients who smoke to a telephone quit line. The methods are comparative feedback (doctors receive information comparing their rates of referring patients to the quit line with those of other doctors, particularly with other doctors who refer at high rates) and postcards reminding them about quit line services. The quit line is a 24-hour service staffed by trained nurses who counsel callers in how to quit smoking and keep from starting again.

    What This Study Found Doctors who receive comparative feedback refer patients to a smoking quit line at higher rates than doctors who receive a postcard reminder. The estimated number of referred smokers who quit was 66 in the feedback group and 36 in the postcard reminder group. The added cost to develop feedback information was about $65 per estimated patient who quits smoking.

    Implications

    • Comparative feedback on referrals to a smoking quit line had a modest effect on doctors.
    • The additional cost of providing feedback information is small considering the effectiveness of the feedback method and the long-term health benefits of stopping smoking.
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The Annals of Family Medicine: 5 (2)
The Annals of Family Medicine
Vol. 5, Issue 2
1 Mar 2007
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Practice-Based Referrals to a Tobacco Cessation Quit Line: Assessing the Impact of Comparative Feedback vs General Reminders
William C. Wadland, Jodi Summers Holtrop, David Weismantel, Pramod K. Pathak, Huda Fadel, Jeff Powell
The Annals of Family Medicine Mar 2007, 5 (2) 135-142; DOI: 10.1370/afm.650

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Practice-Based Referrals to a Tobacco Cessation Quit Line: Assessing the Impact of Comparative Feedback vs General Reminders
William C. Wadland, Jodi Summers Holtrop, David Weismantel, Pramod K. Pathak, Huda Fadel, Jeff Powell
The Annals of Family Medicine Mar 2007, 5 (2) 135-142; DOI: 10.1370/afm.650
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